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David T. Overton, MD; Joseph J. Bocka, MD

Arch Intern Med. 1988;148(7):1617-1619.

Abstract
• It has been reported that the finding of a normal Pao₂ level on arterial blood gas analysis does not exclude the diagnosis of acute pulmonary embolism. We wished to determine whether a more thorough evaluation of the blood gases would prove more helpful; specifically, whether it is possible for a patient with acute pulmonary embolism to have a normal alveolar-arterial (A-a) oxygen gradient. We studied this question In a patient population in which the diagnosis was definitively made via pulmonary arterlography. Sixty-four patients met all study criteria. In these patients, the A-a gradient ranged from 11.6 to 83.9 mm Hg (mean, 41.8 mm Hg). In three patients, the A-a gradient was normal for age. We conclude that a normal A-a oxygen gradient does not exclude the diagnosis of acute pulmonary embolism, and should not preclude further diagnostic procedures if there is a high index of suspicion.

(Arch Intern Med 1988;148:1617-1619)

Author Affiliations
From the Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Mich.

Footnotes
Accepted for publication Feb 17, 1988.

Presented in part at the annual meeting of the University Association for Emergency Medicine, Philadelphia, May 21, 1987.

Reprint requests to Department of Emergency Medicine, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48072 (Dr Overton).

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